Agenda and minutes

Apologies for absence were received from Councillors Clarke and Crozer. 

To approve the record of the meeting held on 7 December 2023.

The record of the meeting held on 7 December 2023 was agreed and signed by the Chairperson as correct. 

The Chairperson will announce any late items which do not appear on the main agenda but which he/she has agreed should be considered by reason of special circumstances to be specified in the report. 

There were none. 

Members are invited to disclose any Disclosable Pecuniary Interests or Other Significant Interests in accordance with the Member Code of Conduct. Guidance on this is set out in agenda item 4.

Disclosable pecuniary interests

There were none.

Other significant interests (OSIs)

There were none.

Other interests

There were none.

The aim of this report is to describe in high-level terms our patients’ in-patient journey from, admission to treatment and discharge from in-patient care to an alternative setting. This report seeks to highlight the current processes, challenges and the on-going improvement work which will deliver cohesive, patient centered mental health care to the people of Kent & Medway.

In addition, an overview of safeguarding activity at KMPT has been included in this report.

Discussion:

The Director of Partnerships and Transformation from the Kent & Medway NHS & Social Care Partnership Trust (KMPT) introduced the report which detailed the in-patient journey from admission to treatment and discharge to alternative settings. It highlighted the current processes, challenges and on-going improvement work. It also included an overview of safeguarding activity at KMPT.

Members then raised a number of questions and comments, which included:

·      Communication – in response to a question about how the information relating to the improvements would be disseminated across the wider workforce, the KMPT representatives confirmed engagement would take place across the Trust and partner organisations, as well as the Community and Voluntary Sector to map out the complexity of support available. In addition, the Assistant Director, Adult Social Care, confirmed that from a social care perspective work was also starting in terms of the communications to ensure referrals are made to the right place.

·      Patient voice – in response to a question regarding how patients and carers were listened to, the KMPT representatives explained that there was a real focus on community engagement and a commitment to co-production of services.  In addition, there had been investment into making services more friendly with an enhanced therapeutic support offer.

·      Discharges – in response to a question about the timeliness of discharges and whether these were happening too early for patients, the KMPT representatives explained that the focus was on making sure a patient’s time in hospital was being spent with the most effective care and that the right support was lined up for patients at the point of discharge to support their continued recovery.

·       Out of area placements – in response to a number of questions regarding out of area placements, KMPT representatives explained that these predominantly related to females due to there being a lack of inpatient ICU beds within the Trust and therefore work was carried out with providers to secure provision, often elsewhere in Kent, such as in Sevenoaks. It was also confirmed that there were no patients out of area because of a lack of beds as of that day, but when patients were placed out of area due to capacity, rather than because of a specialist need, work was done to get those patents relocated back in area as soon as possible. 

·      Impact of universities located in Medway – it was asked whether the universities located in Medway resulted in a higher demand amongst university students and whether this added pressure to the system.  The KMPT representatives explained that this did not increase demand on in-patient facilities as this age group were more likely to require community services and added that universities often provided students with mental health support directly.

·      Kent & Medway Listens – reference was made to an engagement exercise undertaken by the Community and Voluntary Sector called Kent and Medway Listens and whether responses to that had been taken account of when redesigning services.  The representatives present confirmed that they had worked closely with Healthwatch and the Health and  ...  view the full minutes text for item 531.

This report and attached action plan outline the progress made in implementing the 14 recommendations from the GP Access Task Group report of June 2023.

Discussion:

The Consultant in Public Health Medicine introduced the report which outlined the progress made in implementing the 14 recommendations made by the GP Access Task Group, which had been approved by the Cabinet in June 2023. He also referred to the unprecedented pressure being experiences in the NHS. The Director of Primary and Community (Out of Hospital) Care NHS Kent and Medway added that there was an error in one of the report’s recommendations in relation to the Integrated Care Board (ICB) ensuring that GP practices were following BMA’s safe working in general practice guideline.  He explained that the ICB had no powers to enforce this but did offer a package of support around wellbeing.

The Committee then asked a number of questions and comments which included:

·      Training – in response to a question about the take up by GPs of training positions in Medway it was explained that it was a little too early to tell but feedback had been positive, and it was felt this would increase interest across the general practice community.

·      GP attraction offer – reference was made to the GP attraction offer which was working well in terms of supporting GPs to settle in Medway and other areas of Kent with particularly low GP numbers, such as Thanet. It was also mentioned that managed workloads for GPs were crucial to attract more people into the profession.

·      Culture shift in access primary care – it was acknowledged that there was still much to be done in getting the community to both understand, accept and trust that they can get care from various members of the primary care team, not just GPs. The public should be directed to the professional best placed to meet the individual’s needs. Furthermore, the ratio of patient to wider primary care staff was much more positive.

§  Pharmacies – reference was made to the crucial relationship between general practice and pharmacies and the Pharmacy First service, which would commence at the end of the month. This service would enable pharmacies to provide advice and NHS-funded treatment, where clinically appropriate, for seven common conditions, including sinusitis, sore throat, ear infection, infected insect bite, impetigo, shingles and uncomplicated urinary tract infections in women. Work on communicating this to the public was ongoing.

·      Efficiencies – it was confirmed that it cost more for patients to be seen in the hospital’s Emergency Department (ED) and therefore focus needed to be put on preventative methods and enabling access to other health services, such as Urgent Treatment Centres, to avoid people attending ED unnecessarily.

Decision:

The Committee noted the updates and progress achieved in implementing the recommendations from the GP Access in Medway Task Group report of June 2023.

Attached is a covering report to a paper from the Integrated Care Board (ICB) which will give an update on the transformation of community services.

Please note that the paper from the ICB is to follow.

Discussion:

The Director of System Commissioning & Operational Planning for the Integrated Care Board introduced the report which provided an update on the procurement of community services, following previous reports in September and December 2023.

The following three visitors representing different organisations and perspectives were then asked about their views on the transformation, the timescales and whether they thought that services would be improved as a result.

·      The Chief Executive of Medway NHS Foundation Trust, who responded that for some of the transformation, it needed to happen now in order to improve experience and outcomes for service users.

·      The Chief Executive of Medway Community Healthcare, who responded that the timescale was ambitious but again, through the Health and Car Partnership, it was envisaged that some change could be achieved sooner to meet the needs of the community, but that the transformation needed to be done in partnership.

·       The Deputy Leader of Medway Council, who responded that services needed to be reviewed and the re-design was an opportunity to revisit service level agreements to gain clarity around expectations to meet demand. However, concerns were raised around the ambitious timeframe and the potential bureaucracy being suggested and the lack of partnership leadership across the process.

Members then asked a number of questions and comments which included:

·      Progress – in response to comments around further detail and engagement being required, the ICB representatives concurred with this view and explained that work was very much still underway to refine pathways.  Although initially there had been 11 services highlighted for transformation, it would not be possible to do all 11 within the timeframe and so focus would be placed on 2-4 of the 11 to ensure transformation was meaningful and effective.

·      Key Performance Indicators (KPIs) – in response to a request for data and KPIs to inform decision making the ICB representatives confirmed that this work would be done and was key to inform what services to prioritise in order to get the best benefit for service users.

·      Relationships –  the importance of the relationship between partners, including the Council, to deliver this important transformation for Medway residents and Community Health Services was referred to. This needed to sit within an integrated system built on consultation, partner co-design, patient voice and transparency, which was vital for there to be confidence in the system and the service. The representatives from the ICB recognised and acknowledged this, expressing their wish to use the process to deliver the re-design in an integrated way, to build trust and effective relationships with partners.

Decision:

The Committee agreed that the proposals from the Integrated Care Board did constitute a substantial variation or development in the provision of health services in Medway.

This report introduces the Kent and Medway Safeguarding Adults Board’s (KMSAB) Annual Report for April 2022–March 2023.  The Annual Report sets out the responsibilities and structure of the Board and details how the multi-agency partnership delivered against its strategic priorities for the year.  The report also provides information pertaining to safeguarding adults reviews and safeguarding activity.

Discussion:

The Independent Chair and the Manager of the Kent and Medway Safeguarding Adults Board introduced the report which set out the responsibilities and structure of the Board and how the multi-agency partnership delivered against its strategic priorities for the year. The report also provided information pertaining to safeguarding adults reviews and safeguarding activity. They added that they would attempt to provide some information that related to just Medway in the next annual report, where the information was possible to separate out.

Members then raised a number of questions and comments, which included:

·      Multi-agency working – in response to a query about the risks around multi-agency working and whether there was evidence of learning and improvement in this area, the Board Manager explained that there was some improvement in this area and referred to a multi-agency risk management process the Board was developing to demonstrate best practice in working together for high risk cases. This had been identified in other areas as best practice. The Independent Chair of the Board added that in Medway relationships were well developed and effective, referring particularly to joint working with the Community Safety Partnership and with other organisations, including the Council.

·      Referrals increase – in response to a question as to whether the increase in safeguarding adults review referrals was due to increased cases or increased awareness of reporting concerns, the Independent Chair explained that the Board had put great effort into raising awareness to the public, as well as agencies with increased engagement from policing and Medical Examiners. There was also a self-assessment process, which agencies completed every 2 years, which included a question on how they make their staff aware of the safeguarding adults review criteria and process. The Assistant Director, Adult Social Care also referred to the work that had been done across the service to raise knowledge and awareness which had seen an increase of 69% over 5 years in referrals for safeguarding concerns. 

·      Discharge from in-patient mental health services – reference was made to a discussion earlier in the meeting about whether these discharges were too soon and the Independent Chair was asked if this was a concern.  He responded that the role of the Independent Chair was to understand safeguarding practice and to learn, not attribute blame.  When there were issues and areas of concern that were repeated, despite remedial actions, the relevant agency was approached to identify issues and provide assurance, but there would be significant evidence for such challenge.

·      Defensible decision making – it was suggested this phrase could be misinterpreted and the Board representatives undertook to rephrase this in future reports.

·      Repeat referrals – in response to a question about whether repeat referrals in relation to individuals were flagged, the Assistant Director, Adult Social Care reassured the Committee that this would be flagged by social care staff in the Council and the staff were being encouraged to use professional curiosity to improve the safety and wellbeing of service users.

·      Training – reference was made  ...  view the full minutes text for item 534.

Discussion:

The Democratic Services Officer introduced the report which provided the Committee with its work programme for future activity.

The Chairperson also drew the Committee’s attention to a number of visits the Committee had coming up, including a visit to Medway Community Healthcare on Saturday 20 January 2024, as well as forthcoming visits to Ruby Ward (KMPT), the new ambulance station at Twydall and there would also be a visit suggested to Medway Maritime Hospital and its Emergency Department.

Decision:

The Committee agreed the work programme as set out at Appendix 1 to the report, subject to accepting the proposed changes, outlined in italic text.